Emergency Radiology

, Volume 25, Issue 2, pp 121–127 | Cite as

Clinical and imaging features in lung torsion and description of a novel imaging sign

  • Mark M. Hammer
  • Rachna Madan
Original Article



We set out to identify the clinical and imaging features seen in lung torsion, a rare but emergent diagnosis leading to vascular compromise of a lobe or entire lung.


We retrospectively identified 10 patients with torsion who underwent chest CT. We evaluated each case for the presence of bronchial obstruction and abnormal fissure orientation. In seven patients who underwent contrast-enhanced CTs, we assessed for the presence of the antler sign, a novel sign seen on axial images demonstrating abnormal curvature of the artery and branches originating on one side.


Five patients had right middle lobe (RML) torsion after right upper lobectomy, and the remaining occurred following thoracentesis, aortic surgery, or spontaneously. Chest CTs demonstrated bronchial obstruction in eight cases and presence of abnormal fissure orientation in four patients. The antler sign was present in three patients with whole-lung torsion and one patient with lobar torsion; vascular swirling was seen on 3-D images in all seven patients with contrast-enhanced CTs.


Lung parenchymal imaging findings in lung torsion may be non-specific. Identification of the antler sign on contrast-enhanced chest CT, in combination with other signs such as bronchial obstruction and abnormal fissure orientation, indicates rotation of the bronchovascular pedicle. The presence of this sign should prompt further evaluation with 3-dimensional reconstructions.


Lung torsion Lobar torsion Lung resection CT pulmonary angiogram 3D reconstruction 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Dai J, Xie D, Wang H et al (2016) Predictors of survival in lung torsion: a systematic review and pooled analysis. J Thorac Cardiovasc Surg 152:737–745.e3. CrossRefPubMedGoogle Scholar
  2. 2.
    Cable DG, Deschamps C, Allen MS et al (2001) Lobar torsion after pulmonary resection: presentation and outcome. J Thorac Cardiovasc Surg 122:1091–1093. CrossRefPubMedGoogle Scholar
  3. 3.
    Gilkeson RC, Lange P, Kirby TJ (2000) Lung torsion after lung transplantation. Am J Roentgenol 174:1341–1343. CrossRefGoogle Scholar
  4. 4.
    Irie M, Okumura N, Nakano J et al (2014) Spontaneous whole-lung torsion after massive pleural effusion and atelectasis. Ann Thorac Surg 97:329–332. CrossRefPubMedGoogle Scholar
  5. 5.
    Lubner MG, Simard ML, Peterson CM et al (2013) Emergent and nonemergent nonbowel torsion: spectrum of imaging and clinical findings. Radiographics 33:155–173. CrossRefPubMedGoogle Scholar
  6. 6.
    Felson B (1987) Lung torsion: radiographic findings in nine cases. Radiology 162:631–638. CrossRefPubMedGoogle Scholar
  7. 7.
    Kim EA, Lee KS, Shim YM et al (2002) Radiographic and CT findings in complications following pulmonary resection. Radiographics 22:67–86. CrossRefPubMedGoogle Scholar
  8. 8.
    Chung S-H, Nam JE, Choe KO et al (2010) Radiologic findings of lung lobe torsion in reconstructed multidetector computed tomography image lead to early detection. Clin Imaging 34:400–403. CrossRefPubMedGoogle Scholar
  9. 9.
    Niekel MC, Horsch AD, Ven M et al (2009) Right middle lobe torsion: evaluation with CT angiography. Emerg Radiol 16:387. CrossRefPubMedGoogle Scholar
  10. 10.
    Cox CS, Decker SJ, Rolfe M et al (2016) Middle lobe torsion after unilateral lung transplant. J Radiol Case Rep 10:15–21. PubMedPubMedCentralGoogle Scholar

Copyright information

© American Society of Emergency Radiology 2017

Authors and Affiliations

  1. 1.Department of Radiology, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA

Personalised recommendations